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Te Poka Pū is a Kaupapa Māori national surgical interest group that supports Māori doctors and medical students in Aotearoa who are interested in surgery. The group was formed to address the shortage of Māori surgeons and is committed to revitalizing te reo Māori and tikanga Māori as part of improving Māori health equity in surgery. Te Poka Pū conducts research, provides mentorship, and creates opportunities to strengthen relationships between Māori communities and surgeons. They have established an online support network and delivered webinars to connect Māori surgeons and academics. The group aims to conduct rigorous Kaupapa Māori research and develop solutions that prioritize the needs of Māori communities. [Extracted from the article]

This article provides a summary of available data on Māori ocular health, highlighting significant disparities between Māori and non‐Māori populations. Māori are more likely to develop diabetes, sight‐threatening retinopathy and keratoconus, and present for cataract surgery earlier with more advanced disease. Limited data exists for macular degeneration and glaucoma, but there is some suggestion that Māori may have lower prevalence rates. The article emphasises the urgent need for robust national data on Māori ocular health to enable targeted interventions and funding allocation. Achieving equity for Māori in all aspects of health, including ocular health, requires concerted efforts from all stakeholders. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The Royal Australasian College of Surgeons (RACS) Te Rautaki Māori cites the need for more research dedicated to health equity in surgery for Māori. However, the gaps in research for Māori in surgery have not yet been highlighted. This review is the first in a series of reviews named Te Ara Pokanga that seeks to identify these gaps over all nine surgical specialties. The aim of this study was to assess neurosurgical disease incidence and perioperative outcomes for Māori at any point from referral through to the postoperative period.A systematic review of Māori neurosurgical disease and care for Māori in NZ was performed. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement assisted study selection and reporting. Kaupapa Māori (Māori‐centred) research methodology and the Māori Framework were utilized to evaluate Māori research responsiveness.Nine studies were included in this review. All studies were retrospective cohort studies and only two studies had at least one Māori clinical or academic expert named on their research team. Therefore, only one study was deemed responsive to Māori. Studies assessing long‐term outcomes from the management of neurosurgical disease for Māori and patient and whānau experiences of neurosurgical care are lacking.This study indicates the limited scope of research conducted for Māori in neurosurgery. The broader clinical implications of this review highlight the need for good quality research to investigate access to and long‐term outcomes from the management of neurosurgical disease for Māori. [ABSTRACT FROM AUTHOR]

Research surrounding access to surgical care between Maori and non-Maori has grown substantially (Fig. Despite a plethora of resources outlining how to conduct safe and responsive research for Maori, non-Maori researchers with little connection to Maori communities and people continue to lead and control research on or about Maori.1 Maori health clinicians and academics tirelessly challenge these researchers and attempt to protect Maori from research that is racist, exploitative and demeaning. Within these discourses, Maori are often framed within a deficit lens in health research.8 Such deficiencies are framed as either biological or cultural, or both, due to mainstream research methodologies lacking critical reflexivity of Western systems that maintain inequities.9 Furthermore, there is limited research examining the impact of sociocultural systems developed by the dominant group on Maori health. [Extracted from the article]

Objectives: Type 2 diabetes mellitus (T2DM) and periodontal disease are two highly prevalent, directly and independently associated long‐term conditions that disproportionately impact Indigenous Māori in New Zealand (NZ). Although poorly understood, a number of social and biological mechanisms connect these conditions. This qualitative study explored experiences of T2DM and oral and dental (hereafter oral/dental) health; access to oral/dental health care; whether participants' experiences supported or challenged existing evidence; and sought suggestions for improving oral/dental health in a high‐deprivation rural area of Northland, NZ. Methods: Participants (n = 33) meeting the study criteria: self‐identified Māori ethnicity, aged ≥ 18‐years with glycated haemoglobin (HBA1c) >65 mmol/L were recruited via the local primary care clinic in September‐December 2015; two left the study prior to data collection. During face‐to‐face semi‐structured interviews, participants (n = 31) were asked How does diabetes affect your teeth? and When did you last access dental care? Kaupapa Māori (KM) theory and methodology provided an important decolonizing lens to critically analyse the fundamental causes of Indigenous health inequities. Results: Independent analysis of qualitative data by three KM researchers identified four themes: access barriers to quality care; pathways to edentulism; the 'cost' of edentulism; and, unmet need. Results contributed towards informing Mana Tū—an evidence‐based KM programme for diabetes in primary care—to be introduced in this and other communities from 2018. Conclusions: Oral health is integral to diabetes management, and vice versa. Subsidized specialist referrals for oral‐dental health care for Māori with T2DM could improve glycaemic control and diabetes outcomes and reduce diabetes‐related complications among this population. [ABSTRACT FROM AUTHOR]

Background: Health equity is a fundamental right afforded to all regardless of ethnicity. However, in New Zealand (NZ), health inequities are most compelling for Indigenous Māori who experience inadequate access to services, poorer quality of care and poor health outcomes as a result. Bariatric surgery is the most effective intervention for weight loss and remission of obesity‐related disease where all other interventions have been exhausted. This Kaupapa Māori qualitative study presents Māori perspectives of bariatric surgery from the largest public bariatric centre in NZ and offers solutions for enhancing bariatric service responsiveness to Māori. Methods: This qualitative study was informed by Kaupapa Māori methodology and involved a general inductive thematic analysis of 31 semi‐structured interviews with Māori patients who had bariatric surgery at Counties Manukau Health in South Auckland, NZ. Results: Four key themes were identified following analysis: (i) Kaupapa Māori standards of health; (ii) bariatric mentors; (iii) bariatric psychologists; and (iv) community‐integrated support. These themes offer four tangible solutions for optimizing bariatric pathways for Māori from the perspectives of Māori bariatric patients. Conclusion: Kaupapa Māori, community‐centred and greater non‐surgeon aspects of bariatric supportive mechanisms comprise key areas of opportunity for public bariatric pathways in NZ. Surgical leadership is required to advance health equity and service responsiveness to Māori. [ABSTRACT FROM AUTHOR]

To examine differences in incidence, prevalence and screening for diabetic retinopathy in New Zealand, we searched MEDLINE, EMBASE and CINAHL up to 6 December 2018 for observational studies reporting diabetic eye disease or attendance at retinal screening, disaggregated by ethnicity. Two authors separately screened and selected studies, and extracted data. None of the 11 included studies reported data on visual impairment from diabetic retinopathy. All nine studies reporting diabetic eye disease by ethnicity found Pacific people and Māori had higher rates of sight‐threatening disease and lower rates of screening attendance compared to Europeans. Data for Asian people were infrequently reported, but when they were, they also fared worse than Europeans. This review highlights that equity‐focused strategies are needed to address ethnic disparities in eye health among New Zealanders with diabetes. The review also identifies how research methods can be strengthened to enable future calculation of robust disease prevalence estimates. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery has become topical in the media worldwide, influencing wider societal attitudes towards obesity and obesity management. This study aims to explore the media portrayal of bariatric surgery in all print news articles published in New Zealand (NZ) over a decade. Methods: An electronic search of two databases (Proquest Australia/NZ Newsstream and Newztext) and two NZ news media websites (Stuff and the NZ Herald) was performed to retrieve print news articles reporting stories, opinion pieces or editorials regarding bariatric surgery published between January 2007 to June 2017. Qualitative thematic analysis was performed on all included articles. Results: From January 2007 to December 2017, 252 articles related to bariatric surgery were published. Seven major themes emerged centred around barriers to accessing bariatric surgery, deficit attitudes towards obesity and social justice. These views were driven by articles that debated the limited number of publicly funded bariatric procedures offered in NZ. In addition, healthcare professionals used the media as a platform to challenge discriminatory attitudes towards obesity and bariatric surgery. Conclusion: The NZ media is a powerful tool that still bolsters binary perspectives of obesity and bariatric surgery which may work against addressing the obesity epidemic. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery, in recent times, has gained media attention that has influenced individual, healthcare provider and wider societal attitudes towards bariatric surgery. Studies exploring public and media levels of interest in bariatric surgery have been performed overseas but studies within New Zealand (NZ) are scarce. Analysis of Google Trends data may be a useful source of information in investigating public interest levels in bariatric surgery. We aimed to analyse Google Trends information on Internet searches in NZ and to explore sequential relationships with relevant changes in policy. Methods: Key search terms for our Google Trends query were retrieved by independently reviewing news articles relating to bariatric surgery in NZ published between January 2007 and December 2017 and following a brainstorming session. Trend analyses were performed using Microsoft Excel 14.7.2. Data were captured for both NZ and worldwide search interests in Google Trends. Results: Trend analyses showed that total search volumes for 'lap band' and 'lap band surgery' declined while 'gastric sleeve' and 'gastric sleeve surgery' increased exponentially over the 10‐year period. Furthermore, search interests for key terms in NZ were comparable with those worldwide. Conclusion: Our findings reveal that search interests related to bariatric surgery in NZ mirror those worldwide. This includes the popularity of some bariatric procedures over others. The use of Google Trends may provide us with an additional tool to evaluate public interest levels related to bariatric surgery in NZ and could add value in examining the socio‐cultural and political contexts of obesity and bariatric surgery. [ABSTRACT FROM AUTHOR]

Background: Health equity for Indigenous peoples in the context of surgery has recently become topical amongst surgeons in Australasia. Health inequities are amongst the most consistent and compelling disparities between Māori and New Zealand Europeans (NZE) in New Zealand (NZ). We aimed to investigate where ethnic disparities in surgical care may occur and highlight some of the potential contributing factors, over all surgical specialties, between Māori and NZE adults in NZ. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. A series of electronic searches were performed in Medline, Embase, PubMed and CINAHL. Results: Ten studies met the inclusion criteria. All studies employed a range of indicators for surgical care including receipt of surgery following diagnosis, delays to treatment and post‐operative morbidity and mortality. Disparities in the receipt of surgical treatment for several cancers were observed for Māori and remained after adjustment for socioeconomic variables and extent of disease. Māori were more likely to experience delays in treatment and referral to other medical specialties involved in their care. Conclusion: Despite the significant variation in the types of diseases, procedures and indicators of surgical care of the included studies, consistent findings are that disparities in different aspects of surgical care exist between Māori and NZE in NZ. This review highlights the need to better quantify the important issue of health equity for Māori in surgery given the lack of studies over the majority of surgical specialties. [ABSTRACT FROM AUTHOR]

Background: Publicly funded bariatric surgery in New Zealand (NZ) is steadily on the rise to meet the obesity epidemic. Ethnic disparities in obesity rates exist in NZ with Māori and Pacific people having three to five times higher rates than all other ethnic groups within NZ. Ethnic disparities in rates of bariatric surgery have been reported internationally. This research sought to describe rates of publically funded bariatric surgery by self‐identified ethnicity in NZ. Methods: Using reported census and hospitalization discharge data from Statistics NZ and the NZ Ministry of Health, we calculated estimate rates of publicly funded bariatric surgery in the morbidly obese population from June 2009 to July 2014. Results: The average number of publicly funded bariatric procedures performed per 1000 morbidly obese patients from June 2009 to July 2014 was 3.0 for European, 1.4 for Māori and 0.7 for Pacific ethnicities. Conclusion: While these data should be interpreted cautiously due to data limitations, the estimated rates may indicate that bariatric services are currently being provided inequitably across the major ethnic groups within NZ. We suggest that further studies should be performed to explore potential patient, healthcare provider and system‐level factors that may contribute to ethnic disparities in the rates of publicly funded bariatric surgery in NZ. [ABSTRACT FROM AUTHOR]

Abstract: Background: Atrial fibrillation (AF) is a major risk factor for ischaemic stroke and cardiovascular events. In New Zealand (NZ), Māori (indigenous New Zealanders) and Pacific people experience higher rates of AF compared with non‐Māori/non‐Pacific people. Aim: To describe a primary care population with AF in NZ. Stroke risk and medication adherence according to ethnicity are also detailed. Methods: Electronic medical records for adults (≥20 years, n = 135 840, including 19 918 Māori and 43 634 Pacific people) enrolled at 37 NZ general practices were analysed for AF diagnosis and associated medication prescription information. Results: The overall prevalence of non‐valvular AF (NVAF) in this population was 1.3% (1769), and increased with age (4.4% in people ≥55 years). Māori aged ≥55 years were more likely to be diagnosed with NVAF (7.3%) than Pacific (4.0%) and non‐Māori/non‐Pacific people (4.1%, P < 0.001). Māori and Pacific NVAF patients were diagnosed with AF 10 years earlier than non‐Māori/non‐Pacific patients (median age of diagnosis: Māori = 60 years, Pacific = 61 years, non‐Māori/non‐Pacific = 71 years, P < 0.001). Overall, 67% of NVAF patients were at high risk for stroke (CHA2DS2‐VASc ≥ 2) at the time of AF diagnosis. Almost half (48%) of Māori and Pacific NVAF patients aged <65 years were at high risk for stroke, compared with 22% of non‐Māori/non‐Pacific (P < 0.001). Irrespective of ethnic group, adherence to AF medication was suboptimal in those NVAF patients with a high risk of stroke or with stroke history. Conclusion: AF screening and stroke thromboprophylaxis in Māori and Pacific people could start below the age of 65 years in NZ. [ABSTRACT FROM AUTHOR]

Knowledge about aspects that influence recovery and adaptation in the postacute phase of disabling health events is key to understanding how best to provide appropriate rehabilitation and health services. Qualitative longitudinal research makes it possible to look for patterns, key time points and critical moments that could be vital for interventions and supports. However, strategies that support robust data management and analysis for longitudinal qualitative research in health-care are not well documented in the literature. This article reviews three challenges encountered in a large longitudinal qualitative descriptive study about experiences of recovery and adaptation after traumatic brain injury in New Zealand, and the strategies and technologies used to address them. These were (i) tracking coding and analysis decisions during an extended analysis period; (ii) navigating interpretations over time and in response to new data; and (iii) exploiting data volume and complexity. Concept mapping during coding review, a considered combination of information technologies, employing both cross-sectional and narrative analysis, and an expectation that subanalyses would be required for key topics helped us manage the study in a way that facilitated useful and novel insights. These strategies could be applied in other qualitative longitudinal studies in healthcare inquiry to optimise data analysis and stimulate important insights. [ABSTRACT FROM AUTHOR]

Background and objective There are significant health disparities between Māori and non-Māori with asthma, a pattern seen between other ethnic populations. This study investigates outcomes for Māori in a randomized controlled trial ( RCT) of combination budesonide/formoterol inhaler therapy in asthma. Methods This 24-week multicentre RCT recruited 303 adult asthma patients, 44 of whom were Māori. Participants were randomized to the single combination budesonide/formoterol inhaler as maintenance and reliever therapy (' SMART') regimen or 'standard' regimen (combination budesonide/formoterol inhaler for maintenance and salbutamol as reliever). Outcomes included patterns of beta-agonist inhaler use including 'high use' of reliever therapy (>8 actuations of budesonide/formoterol in excess of four maintenance doses per day for SMART and >16 actuations per day of salbutamol for standard). Differences in outcomes for Māori versus non-Māori were assessed using an interaction term between ethnicity and treatment. Results With adjustment for ethnicity, the SMART group had fewer days of high use (relative rate ( RR) 0.57 (95% confidence interval (CI): 0.38-0.85)), days of high use without medical review within 48 h ( RR 0.49 (95% CI: 0.32-0.75)) and severe exacerbations (RR 0.54 (95% CI: 0.36-0.81)) compared with standard. The magnitude of the benefit from the SMART regimen was similar in Māori and non- Māori. Regardless of treatment regimen, Māori demonstrated more days of high use, high use without medical review and underuse of maintenance therapy. Conclusions The SMART regimen has a favourable risk/benefit profile in Māori. Days of high use, days of high use without medical review and underuse of maintenance treatment were greater in Māori, regardless of treatment regimen. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether cannabis smoking increases the risk of head and neck cancer. Design: Case-control study. Subjects and Methods: Cases of head and neck cancer ≤55 years identified from hospital databases and the Cancer Registry, and controls randomly selected from the electoral roll completed interviewer-administered questionnaires. Logistic regression was used to estimate the relative risk of head and neck cancer. Results: There were 75 cases and 319 controls. An increased risk of cancer was found with increasing tobacco use, alcohol consumption, and decreased income but not increasing cannabis use. The highest tertile of cannabis use (>8.3 joint years) was associated with a nonsignificant increased risk of cancer (relative risk = 1.6, 95% confidence interval, 0.5-5.2) after adjustment for confounding variables. Conclusions: Cannabis use did not increase the risk of head and neck cancer; however, because of the limited power and duration of use studied, a small or longer-term effect cannot be excluded. [Copyright &y& Elsevier]

Background Methods Results Conclusions The Royal Australasian College of Surgeons (RACS) recently instituted cultural safety and cultural competency as its 10th competency with formalized cultural safety training yet to be instituted. Wānanga are Indigenous Māori teaching institutions that can be used contemporarily for cultural safety training.In 2022, surgical registrars based at Taranaki Base Hospital (TBH) held in‐hospital wānanga ranging from 1 to 3 h focussed on cultural safety, professionalism and wellbeing. This study explores the perspectives of these registrars who attended wānanga using a Kaupapa Māori aligned methodological stance and interpretive phenomenological analysis.Twenty‐six wānanga were held from March 22nd 2022 to January 30th 2023. Six registrars provided their perspectives with four major themes emerging from their stories including: cultural safety; unity; time, place and person; and a new era. Registrars valued the wānanga which was scheduled for Friday afternoons after daily clinical duties. Wānanga facilitated unity and understanding with registrars being able to reflect on the context within which they are practicing – describing it as a new era of surgical training. ‘Time’ was the biggest barrier to attend wānanga however, the number of wānanga held was testament to the commitment of the registrars.Regular wānanga set up by, and for, surgical registrars cultural safety development is feasible and well subscribed in a rural or provincial NZ setting. We present one coalface method of regular cultural safety training and development for surgical registrars and trainees in NZ. [ABSTRACT FROM AUTHOR]